Golden Jubilee National Hospital

BACKGROUND:The pullback pressure gradient (PPG) is a novel physiological metric that quantifies coronary artery disease patterns as focal or diffuse on a scale from 0 to 1. This study assessed the relationship between PPG and residual angina at 1 year.METHODS:PPG Global is a prospective, investigator-initiated, single-arm, multicenter study that enrolled patients with at least 1 lesion with a fractional flow reserve ≤0.80 intended to be treated with percutaneous coronary intervention. After the PPG calculation, physicians could revise treatment assignment to medical therapy or coronary artery bypass graft surgery instead of percutaneous coronary intervention. Focal and diffuse disease were defined based on the median PPG value of 0.62. Patient-reported outcomes were assessed using the Seattle Angina Questionnaire at baseline and 1-year follow-up.RESULTS:The study included 947 patients with PPG and the Seattle Angina Questionnaire at 1 year. The mean age was 67.6±10.2 years, 24% were female, and 29% had diabetes. At 1 year, patients with focal coronary artery disease reported less angina than those with diffuse disease (Seattle Angina Questionnaire angina frequency score, 95.3±9.9 versus 92.5±15.0; P=0.006). PPG was independently associated with improvement in angina (P=0.017).CONCLUSIONS:In patients with flow-limiting coronary artery disease, a focal disease pattern defined by high PPG was associated with greater symptomatic relief at 1 year compared with diffuse disease (low PPG). By capturing the underlying pathophysiologic distribution of epicardial disease and its relation to post-treatment symptom relief, PPG may support a more tailored revascularization decision-making and percutaneous coronary intervention strategy.

BACKGROUNDIdiopathic pulmonary arterial hypertension (IPAH) alters right ventricular size and function, curtailing life expectancy. Patients may experience angina and myocardial ischemia. However, the underlying mechanisms are poorly understood.METHODSThis study had a cross-sectional, case-control design. Patients with IPAH undergoing right heart catheterization were prospectively enrolled and underwent functional testing during coronary angiography using a dual pressure/temperature-sensitive guidewire. Cardiovascular MRI measured left and right ventricular mass and function. Right ventricular tissue from individuals with end-stage PAH and control individuals were analyzed for pathophysiology.RESULTSEleven IPAH and 15 control participants completed the protocol: 73% of IPAH patients had an elevated index of microcirculatory resistance (IMR > 25) and 55% had reduced coronary flow reserve (CFR < 2.0). Mean IMR was significantly higher in IPAH participants (39.2 ± 27.0 vs. 15.3 ± 5.0, P = 0.002), whereas mean CFR was lower (2.8 ± 2.1 vs. 4.0 ± 1.4; P = 0.077). Paired right coronary artery/ventricular measurements (n = 6) revealed IMR positively correlated with right ventricular mass (r = 0.91, P = 0.12) and negatively with CFR (r = –0.82, P = 0.046). Compared with controls (n = 5), PAH participants (n = 4) had reduced right ventricular capillary density, increased cardiomyocyte area, and increased mural area in pre-capillary arterioles.CONCLUSIONInvasive coronary function testing was feasible and safe in IPAH. Coronary microvascular dysfunction was prevalent in IPAH and correlated with increased right ventricular mass. Histopathology revealed vascular rarefaction and remodeling of pre-capillary arterioles.FUNDINGThe British Heart Foundation (BHF) (PG/18/6134217) and the Golden Jubilee Research Foundation.

Abstract Introduction Adverse left ventricular (LV) remodelling is associated with increased mortality and heart failure following reperfused ST-segment elevation myocardial infarction (STEMI). While both LV global longitudinal strain (GLS) and left atrial (LA) strain have independently demonstrated significant prognostic value for risk assessment in STEMI, the optimal atrial or ventricular functional parameter for risk assessment remains unclear. Purpose To investigate the prognostic significance of atrial and ventricular function indices, to predict early adverse LV remodelling in patients with anterior STEMI. Methods A post-hoc analysis of the European intracoronary cooling evaluation in ST-elevation myocardial infarction (EURO-ICE) trial was performed. In this study, patients with large anterior wall STEMI underwent cardiovascular magnetic resonance (CMR) at baseline (&amp;lt;1 week post-reperfused anterior STEMI) and at the 3-month follow-up. LV adverse remodelling was defined as an increase in LV end-diastolic volume of ≥20%. Left atrioventricular coupling index (LACI) was calculated as the ratio of left atrial end-diastolic volume to LV end-diastolic volume. Atrioventricular (AV) strain was calculated as the sum of LV global longitudinal strain (absolute values) and LA reservoir strain. The Mann-Whitney U test and logistic regression were used to identify differences and predictors of LV remodeling. Results In total, 188 patients were included. At baseline, LV end diastolic volume, LV GLS and LA reservoir strain, LACI, and AV strain were significantly different between patients with and without LV remodelling (table 1). Multivariate logistic regression showed that higher LACI was associated with adverse LV remodelling (p=0.005; table 2). Conclusions Although CMR-derived atrial and ventricular volume, as well as strain are significantly related to LV remodelling in patients with reperfused anterior STEMI, LACI is the strongest, independent predictor of adverse LV remodelling.

Study identifies GDF15 as a biomarker-accurately distinguishing PVOD from other PAH forms and predicting outcomes across PVOD, IPAH, and HPAH-advancing earlier diagnosis and personalized treatment.

Abstract Objectives Computed tomography coronary angiography (CTCA) is a well established diagnostic modality for coronary heart disease (CHD) in stable chest pain strongly endorsed by NICE guidelines. Bottlenecks arising from outpatient capacity constraints add significant delays to rapid access chest pain (RACP) pathways. We evaluated a novel direct track to CTCA from primary care prior to RACP assessment. Methods Patients referred from primary care to an urban academic medical centre (catchment population 650,000) were prospectively vetted direct to CTCA (based on eligibility per NICE CG95) between 5/6/2024 and 29/01/2025. Patients with known CHD or those with contra-indication to CTCA imaging (end stage renal disease or contrast allergy) were excluded. Patients were contacted and offered to participate in this novel pathway. If they declined, patients stayed on the standard-care pathway. A 640-detector scanner (Aquilon ONE, Canon-Toshiba) and sublingual GTN spray was used. Where required, patients received intravenous metoprolol for heart rate control(target 60 b.p.m.) immediately before scan acquisition Routinely collected (usual care) data were gathered by clinicians who were members of the usual care medical team and ethics approval or explicit patient consent was not required. Results One hundred and forty-nine patients (mean age 55 ± 10 years, range 25-81, 34% female) underwent cardiologist supervised CTCA (see figure 1). The presenting symptoms were: non-specific chest pain (24, 14%); atypical chest pain (75,50%); typical chest pain (54, 36%). A majority were diagnosed with no or non-obstructive coronary artery disease by CAD-RADS (Coronary Artery Disease Reporting and Data System) score: 32%, score 0 (no CHD); 37%, score 1-2 (CAD requiring medical therapy); 30%, score 3-5 (moderate-severe CAD). Further face-to-face RACP consultations were only required in 47 (32%) of patients. Only 26 (17%) of patients required exercise electrocardiography at clinic assessment and 22 (15%) underwent invasive coronary angiography for refractory angina. Relevant informant findings were demonstrated in 43 (29) patients (see table 1); 4 (3%) required additional speciality review (respiratory, gastroenterology) for suspected malignancy. Median time to diagnosis was significantly shorter compared to conventional pathway (29 days [IQR: 21-41] vs 88 days [IQR 84-101]). Based on this pathway’s capacity (6 CTCA slots per week) we extrapolated yearly saving of £26,492. Conclusion A direct-to-CTCA approach is a feasible strategy for patients without pre-existing CHD referred to RACP. A unique strength is tailoring preventative therapy based on CTCA findings. Significant reduction in hospital appointments has major implications for relieving congested cardiology pathways.Fig 1 Table 1:Follow-on testing

Abstract Objective This study aims to assess the long-term outcomes and survival of patients who underwent PITA-CABG in multi-vessel myocardial revascularisation with a bespoke surgical site infection (SSI) bundle. Methods PITA-CABG technique involves multi-vessel myocardial revascularization by connecting the right internal thoracic artery (RITA) end-to-side to in-situ left internal thoracic artery (LITA) in a Y-graft with sequential coronary anastamoses. Bilateral internal mammary arteries are harvested by extra-pleural skeletonised technique. A cohort of 924 patients from April 2012 to July 2024 who underwent isolated PITA-CABG was analysed. Survival analysis explored the relationship between Euroscore, left ventricular (LV) function, body mass index, pulmonary disease, extracardiac arteriopathy, and survival. Univariate analysis preceded Cox regression with stepwise variable selection for independent predictors, all at a 5% significance level. Results Mean age is 64 years, and 83.4% (771/924) were male. On average patients received 3.4 anastomoses/patient (2 grafts (105), 3 grafts (425), 4 grafts (334), 5 grafts (52), 6 grafts (8)). Mean cardiopulmonary bypass and mean aortic cross clamp times were 70.1 &amp; 57.1mins, respectively. Rates of SSIs was 2.1% (20/924) total (1.6% (15/924) superficial wound infection, 0.5% (5/924) deep wound infection). 0.4% (4/924) required new onset haemofiltration due to acute renal failure, and 0.2% (2/924) developed a post- operative neurological deficit. The 30 day mortality rate was 0.04% (arrhythmia, n=1 , mesenteric ischaemia, n=1, multiorgan failure, n=1). Survival rates at one, five, and ten years were 98.8%, 93.3%, and 74.4%, respectively (Figure 1). Notably, LV function (Figure 2), pulmonary disease, and extracardiac arteriopathy were identified as independent predictors of survival (p&amp;lt;0.001 for all variables). Patients with poor LV function experienced a 2.9-fold higher mortality risk, while those with moderate LV function had a 2.1-fold higher risk. Additionally, the presence of pulmonary disease increased the risk of death by 1.7 times, and extracardiac arteriopathy was associated with a 2.2-fold higher risk. Conclusions The study reveals a low operative mortality rate for PITA-CABG with a excellent 10- year survival. Patients with compromised LV function, pulmonary diseases, or extracardiac arteriopathy were identified as having a notably increased mortality risk. Wound complications are minimised by employing a bespoke SSI bundle.KM Curve of population KM Curve of varying LV Function

Background/Aim: The use of cell saver technology has revolutionized the management of blood in cardiac surgery, with the objective of reducing the need for allogeneic blood transfusions and enhancing patient outcomes. This study presents a 10-year audit of cell saver use in cardiac surgeries at a tertiary cardiothoracic center in Scotland. Methods: An analysis of data from cardiac surgery cases using cell savers was conducted. The study assessed the quantity of anticoagulant used, the processing of blood, and the recovery of red blood cells. Results: The center consistently employed heparin as the anticoagulant during the review period. The mean age of the 1717 patients was 56.85 years; 66.86% were male and 33.14% were female. The mean blood processed volume was 1646.55 ml and the mean salvaged red cell volume was 544.22 ml over a 10-year period. The deployment of cell savers was most prevalent during coronary artery bypass graft surgeries and major aortic procedures. Conclusion: The potential to minimize blood loss and reduce allogeneic blood transfusions is present in cell saver technology for cardiac surgery. The significance of optimizing cell saver protocols to enhance patient care and efficacy is underscored in the study.